First-year U medical students listen to a histology lecture by Dr. Nicola Philpott, assistant professor of medicine at the U. A Mayo Clinic study published today in the Journal of the American Medical Association found that high rates of burnout increase the likelihood that medical students will cheat on exams or be dishonest in patient care.

Burnout is a common condition among medical students that features a troubling side effect: unprofessional conduct.

The revelation comes from a new study, and researchers say it’s alarming because it suggests burnout could affect everything from honesty and integrity to a doctor-in-training’s willingness to advocate for patients.

“The findings suggest that future physicians’ altruism, and their professionalism, is eroded by burnout,” said Dr. Liselotte Dyrbye, a researcher at the Mayo Clinic in Rochester, Minn.

“Any patient wants their needs to be put first. … If that very premise of patient care is threatened by burnout, (patients) should care.”

The latest survey of 4,400 medical students was led by doctors at the Mayo Clinic and included responses from nearly 2,700 students at Mayo, the University of Minnesota and five other medical schools.

About 53 percent of those who responded to the survey fit the burnout definition because they reported high levels of emotional exhaustion and/or high detachment from patients, Dyrbye said.

Overall, the survey found 43 percent of third- and fourth-year medical students reported a physical examination finding as normal when they had inadvertently omitted it from the exam.

In addition, the survey showed that only 14 percent had opinions about physician relationships with drug and medical device companies that correspond to professional guidelines — a hot topic in the medical world.

The problems were especially pronounced among burnout sufferers, who also were less likely to report holding altruistic views about physicians’ responsibility to society.

The study was being published today in the Journal of the American Medical Association. It follows survey results published in 2008 that showed a similarly high rate of burnout among medical students as well as a link between burnout and suicidal thinking, said Dr. David Power, director of medical student education in the U’s department of family medicine and one of the study’s authors.

The fact that burnout rates aren’t going down is discouraging, Power said, because medical schools are trying to do more to help students with their emotional needs. At the same time, it’s not surprising, given the historical rigors of medical education.

“This idea of having to be stoic, having to be mentally tough and not revealing weakness — certainly that’s been in the history of medicine,” Power said. “Ultimately, patients are suffering if there’s unethical behavior (due to that culture).”

The U has tried to change the culture by hiring staff to help promote personal development and well-being in medical students, Power said. The university also has set limits on work hours for medical students.

At the same time, some stresses are just built into the medical school experience, such as tuition costs of about $40,000 per year. Students typically rack up large debts that can make them feel they have no choice but to finish medical school and then try for a career in a higher-paying specialty.

Today’s study found students with burnout were significantly more likely to have engaged in behaviors such as using a crib sheet or copying from another student during an exam. Burnout victims also were more likely to have reported a physical examination finding as normal when it had been omitted from the actual exam — presumably to cover up the omission from their superiors.

Beyond burnout, the study results suggest medical schools must better educate students about potential problems in collaborating with industry. For example, 22 percent of respondents thought it was appropriate to accept $500 from an industry representative for spending 10 minutes to complete a survey. That view doesn’t square with American Medical Association guidelines.

“Students still have a poor understanding of the relationship with industry,” said Dyrbye, the Mayo Clinic researcher.

P.J. Lally, a third-year medical student at the U, said he was surprised to hear so many of his peers provided wrong answers when it came to questions about doctors’ relationship with industry. The topic has been discussed prominently over the past 18 months at the U, he said, so he chuckled at the idea of taking $500 for a 10-minute survey.

The U has made curriculum changes that help students by reducing the number of class hours and creating more time for independent study, said Lally, 27, of St. Paul. More could be done to help students learn to cope with stress, he said.

“I think a certain amount of the stress level is built into the career choice,” he said. “You can’t really not learn the things you need to learn, and there are times when patient care is emotionally charged.”

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